This course is no longer available

Latest User Comments

I would like to...

Course Availability

This course is only available to trainees days after purchase.
It would need to be repurchased by the trainee if not completed in the allotted time period.
This course is no longer available.
You will need to repurchase if you wish to take the course again.

Description

This lecture reviews the pertinent anatomy pertaining to regulation of gastrointestinal motility, the physiologic mechanisms controlling motility, the pathophysiology of pathologic ileus, and prokinetic therapy with mechanisms of action.

Objectives

Learn the anatomy pertaining to gastrointestinal motility

The regulation of gastrointestinal motility is governed by both intrinsic and extrinsic input. Intrinsic input comes from the enteric nervous system consisting of the myenteric and submucosal plexi, and the primary extrinsic influences are sympathetic and parasympathetic efferent and afferent neurons.

Motility is governed by the complex interaction of the enteric nervous system, the autonomic nervous system, and other endogenous or exogenous mediators such as opioids and prostaglandins. Key neurotransmitters that have excitatory influences on GI smooth muscle include acetylcholine and substance P, whereas inhibitory neurotransmitters include nitric oxide and vasoactive intestinal peptide.

Know the key mechanisms that contribute to pathologic ileus

Ileus can be initiated by multiple disease states including shock, electrolyte imbalances, peritonitis, endotoxemia and ischemia. The underlying pathogenesis for ileus in all of these conditions is inflammation, neurogenic causes, or a combination of the two.

Know the mechanisms of action and sites of action of the most commonly used prokinetic agents

The primary classes of prokinetics include serotonergic agonists/antagonists, dopaminergic antagonists, motilin agonists, acetylcholinesterase inhibitors, sympatholytics and H2 antagonists. Side effects and location of action varies so selection should be based on individual case needs.